On Inaccessibility of Care - focus on Eating Disorders, and a focus on one woman

"Hi Sofia! It's been awhile since we have chatted. Last PM you were fundraising to go back to Monte Nido. I know eventually you ended up going to Carolina House in Durham. I believe Carolina House worked out for you right? :) I'm having a really hard time finding treatment options. I was wondering if you could give me some insight on how I can get a better level of care. I have Medicare for insurance. Would it be possible I could go to a place like called Carolina House? Medicare is just covering IP hospitals and I'm not getting nothing from those stays. Wondering if you knew a way around it?"

(For those who don't know, "PM" stands for "Personal Message", "IP" stands for "Inpatient", as in a hospital; generally shorter term and less quality care for those with longstanding eating disorders.)

I asked for and received permission to post this woman's personal facebook message to me on this blog. First and foremost, I am going to give her (and detail here) all I know about accessing care with:

• shitty insurance
• Medicare
• no insurance whatsoever

But I need to ask all of you who have knowledge on the subject to help her out - as well as anyone who stumbles across this page asking similar questions in the future - by adding your own ideas, experiences, and stories - I told her that I would keep her anonymous in this post, so she will stay that way, but this is a very real situation for a very real person, and she needs our help.

That said - I cannot TELL you how many messages, emails, calls, letters I get asking for help of this nature. Probably because of what she mentioned - that I was once in a position with my insurance company not covering desperately needed care, and that I fund raised. My situation is unique, and it worked out. I wasn't anticipating telling that story so soon, so I'm going to leave it for another day, but trust me - it was a string of miracles, and (god it's 5:30 AM and I have not slept and this may be the cheesiest thing I have EVER said in my life) those miracles were people. Just like you. With knowledge and information and power.
So let's help her, shall we? I'll get to what I know:

1. Shitty Insurance - This was my situation. The National Eating Disorders Association has a whole page detailing how you can fight your insurance company's decisions; on appeals, on everything. But what ultimately saved me was working with a fantastic lawyer, whom many of you have likely heard of, named Lisa Kantor. I trust her with my life. I would not hesitate to contact her firm and see what they can do for you, even if you cannot afford to pay a lawyer. Just try it, and trust me. You can attempt to host your own fund raiser if the need be; this is difficult and tricky. Mine was extremely successful and still only raised about $10,000 - less than 10 days of residential treatment at most facilities, when most places require a minimum of at least 45 days (and that's really fucking minimal). Also a Q & A with Lisa Kantor I found about how to get coverage for your ED. Now, please, please, please - if you have anything to add, add it in the comments section, because I got lucky, and this is as far as I can take you with regard to Shitty Insurance.
2. Medicare - This I know a little about, because of my Shitty Insurance situation. As far as I know, the following centers that specialize in Eating Disorders accept Medicare (please add any that you know of that I have missed): The Klarman Center at McClean Hospital, River Oaks Hospital in New Orleans, Rogers Memorial Hospital in Wisconsin (am I wrong about this? It says they do in one place and that they don't on another site), Walden Behavioral Health in Massachusetts (says they accept Medicare A and Medicare B as well as various Medicaid plans). That was all I could find in my search just now. PLEASE add centers you know of. The crappy thing is that all of the centers I have listed are either Inpatient or known to be similar to Inpatient. I wish I could help more, friend, but this is all I was able to find on short notice. I will email Lisa and ask her what she knows, if anything in addition to the above Q & A, and edit this post if I find anything more out.
3. No Insurance Whatsoever - Laughably, this is almost easier than Medicare. Columbia's NYSPI program has a research unit that provides FREE inpatient care to those who are eligible for their studies. Google around and try to find similar things in other places, because I know they exist - again, I will edit this entry once I find out more myself. Again, you can attempt to fund raise. Some people's families, who are able, take out of their retirement or pay out of pocket (this is almost impossible for most, and for those for whom it IS possible, many have already exhausted all of their own and their family's resources with previous treatment, and it is no longer possible - and they find themselves in a seemingly impossible situation. This is where we put our heads together and work. Hard.)

Now that I've covered those basics, I'm going to rant about what happens to people who have been sick a long while with eating disorders. Often, they can't hold jobs, which means as adults they lose their insurance, and if they're LUCKY wind up on Medicare, which means they only have access to certain programs, and while it's brilliant of those programs to accept Medicare this means their options are sorely limited - which is not good for those with chronic, persistent, severe eating disorders. Often, Inpatient units are extremely short term and based around weight gain/medical stabilization, which is not the only problem (to say the least) when it comes to complex, longstanding eating disorders. Not to mention, in my personal experiences and observations with inpatient treatment (and bouncing in and out of hospitals) it can often be more damaging to the body (that is then refeeding, getting sick again, refeeding, getting sick again) - more of a shock to an already damaged system - than staying sick alone would be. Often people with Anorexia Nervosa become hypermetabolic (which, long story short, means that their metabolisms work on overdrive and make it harder for them to gain weight and easier to lose - when gaining weight is already a tremendous obstacle mentally and emotionally for sufferers of this disease), and while hospitalized, people with Anorexia often become hypermetabolic - making it even crazier to hospitalize and then release them so quickly, as they often just lose all of the weight AND THEN SOME when discharged, which puts them in an even more dangerous position than before.
It would be so fucked up that it's funny, except it's not funny. Not at all. This is a short rant, because I want to keep the focus on this particular woman.

I request your help for this young woman who wants to get herself some help. Any ideas from anyone - especially those who are knowledgeable and have personal experience - are more than welcome.
Thank you again for your time,
Sofia

The Little White Hearse - on death in the community of the mentally ill

The Little White Hearse

By Ella Wheeler Wilcox

 

Somebody’s baby was buried to-day—
The empty white hearse from the grave rumbled back,
And the morning somehow seemed less smiling and gay
As I paused on the walk while it crossed on its way,
And a shadow seemed drawn o’er the sun’s golden track.

Somebody’s baby was laid out to rest,
White as a snowdrop, and fair to behold,
And the soft little hands were crossed over the breast,
And those hands and the lips and the eyelids were pressed
With kisses as hot as the eyelids were cold.

Somebody saw it go out of her sight,
Under the coffin lid—out through the door;
Somebody finds only darkness and blight
All through the glory of summer-sun light;
Somebody’s baby will waken no more.

Somebody’s sorrow is making me weep:
I know not her name, but I echo her cry,
For the dearly bought baby she longed so to keep,
The baby that rode to its long-lasting sleep
In the little white hearse that went rumbling by.

I know not her name, but her sorrow I know;
While I paused on the crossing I lived it once more,
And back to my heart surged that river of woe
That but in the breast of a mother can flow;
For the little white hearse has been, too, at my door.

 

This is a lofty, heavy topic, and I hope I do it some justice. This was the first poem I read in my search, and it felt seamlessly fitting.

As someone who has suffered from mental illness for over half of her life, and who has been in and out of hospitals and treatment programs of various levels of care for eleven years, I have come to know many who have died from various diseases of the mind. Of the people I have known, most have died from eating disorders (a commonly known fact among sufferers but perhaps not among others; eating disorders have the highest mortality rate of any mental illness.)

The others have died by their own hand. And as of late, it seems that more and more people I know or people I know of are dying. It's as though death is literally among those of us who suffer in a packed crowd picking and choosing and taking. The death rate seems to be accelerating. On a forum I frequent many of us have been wondering if it's our age; if because many of us on that forum have been ill for so long and are hitting certain ages (namely our late 20's and early 30's) our bodies and minds have simply had enough. That's a fair assumption, I think, but does it matter? Because it's not just those among my little online community who are dying; it's those of us who have been suffering from mental illness everywhere, all over the world; we are your children, your mothers, your sisters, your brothers - your teachers, your loved ones. We are as precious as the healthy.

I was sixteen years old the first time someone I cared about died as a direct result of mental illness. He was fourteen years old, and he committed suicide. We had been together in a hospital for two weeks when I was fourteen and he had just turned thirteen. He was sweet, and funny, and incredibly smart. His smile was devious and lovely. His name was Gulliver, as of the stories.

I remember getting the phone call from a mutual friend, and how something cracked inside of me as tears streamed down my face at my introduction to grief; little did I know, this introduction was to crescendo years later at the age of 24, when I would lose one of the most dear people in the world to me.

His family was Jewish, and so he was buried the next day. I had never been to a funeral and didn't know what to wear. It seemed custom to wear black, and the only black pants I had (laugh if you want) had a hole in the crotch, so I taped them from the inside out. He was buried at the very top of a steep hill in a Jewish cemetery in Oakland, California. I met my friend at the bottom of the hill as I noticed how crowded it was, how many friends he had had, and how many people had loved him. The sun was mocking us that day; it beat down on our backs, and I sweat as we walked up the nearly perpendicular hill that led to his open grave. I could hear the tape crunching and swishing against itself - crinkle, crinkle, crinkle. It was almost funny, but not quite, and definitely not at the time.

That was my first experience with one of my peers dying. The next that comes to mind was a woman I was a bit closer with - we had been in a treatment program together in Sacramento, California, and she too committed suicide, though she had suffered from anorexia for many, many years and it's plausible that her suicide was related. Her name was Katie, and she was so loving and bright and brilliant. She had nearly completed her PhD in Molecular, Cellular, and Integrative Physiology at the University of California in Davis. She was a lovely human being, and an enormous loss for the world.

Then someone I had heard of, but didn't know personally. Then a few more. And as each pillar fell it seemed they grew closer and closer to me, until I knew one day that I would lose someone I loved very much.

And I can't lie and say I didn't see it coming with her, with my best friend Chrissie, but I was not expecting it on the day it did come. As mentioned in another entry I will not be sharing details of her death that are not well known. Her eating disorder killed her. That crack inside me that had formed when Gulliver died burst, and all of me shattered.

I am still picking up the pieces. July 10th, 2013. The day one of the people I loved the most in the world died at the age of 23, and I became horribly intimate with grief.

And recently - Gretchen Gleason, beloved on my little internet site who I happened to know in person because she too lived in North Carolina. Gretchen, who was personable and funny as hell and a lot of other things I won't mention in a blog entry, but know that I am smiling thinking of her. She died on May 15th of 2014 - just over two weeks ago. She died when her heart stopped in her sleep. And then another - Lauren Bottner, beloved by many in Los Angeles, California - a writer, a great spirit among us. And another - a young man, by his own hand, who I did not know personally. And another, and another.

What can we do? Is it a matter of prevention at this point? Can the "Chronic" sufferers be saved? How can we tell when someone is getting to that point? Do THEY know? How can we prevent it from getting so bad? How can we help people access the care that they need and deserve, and convince them if they do have access to take it?

I can think only of doing whatever I can for myself and for those I know and love who suffer, and suggesting that you do the same, that you choose to care enough to get involved, even when a situation is complicated and not necessarily something you feel like dealing with. Because these are lives we are talking about that are on the line. And, for instance, Gretchen's life - it was on the line at the very beginning of her disorder, before anyone even knew about it. And even with all of the support and love she had from her communities and family, this disease still took her. Levels of support vary among those who die. Almost all are loved by someone.

What can we do?

I'm really asking. If you have suggestions in addition to my own, please comment and start a discussion, because this needs to stop. And the very first step, I think, is making others aware of this endemic.

So now you're aware. Does it make you care more? Human beings are extraordinary and clueless at once! We don't know when we're fourteen and our best friend is kind of throwing up sometimes that ten years later it will kill her. We don't know when our child scratches herself at the age of 10 and we get called in by the school counselor that she will one day commit suicide - our denial gets the best of us, our ignorance, our business, our dedication to our own lives and careers and loved ones - and there's nothing any of us have done wrong when we didn't know there was something there to begin with. But life, if we can agree for a moment, is precious in that it's awarded to each person only once (if that is in your belief system) - for whatever reason from the day we are born the one thing that we can guarantee is that the animated, beautiful, funny little baby with the dimples will one day die. How can we make these deaths less in vain? (Apart from those of us who personally knew and loved them and are certainly doing all we can in this order?)

How can we begin to help one another to care more? To show that care? To DARE to show just how much we care, while we're still alive? How can we lose our fears of rejection and intimacy, of appearing a certain way, long enough to help save a life?

Am I making sense to you? It's very late/early now, and I've been up a terribly long while, but once this topic for this blog hit my brain it was go time, because that first step of awareness can't wait another second.

I invite you to care today, for yourself first and foremost, closely followed by love for all living beings.

Thank you for your time,

Sofia

DBT, Part 1: An Introduction and Distress Tolerance (and a small update on me)

Hello fellows,

I hope you're having an okay Sunday, and that this finds you well.
Before I say anything more let's remind ourselves that Sofia is not a therapist or a physician or anything of the sort; in fact, Sofia has not yet graduated from high school, does not yet have her GED, and is 25 years old. That said, Sofia has twelve years of therapy under her belt, and 25 months of enrollment in a residential program whose primary treatment modality was Dialectical Behavior Therapy, which I'm about to explain. (And for those of you who are wondering, it was a residential center for the treatment of eating disorders that I highly recommend and benefited greatly from called the Carolina House located in Durham, North Carolina, where I live - speaking of which, I should probably get around at some point for those of you who don't know me to who the hell I am and why I started this blog. Hmm. Not today, but someday soon.) Anyway, you'll probably hear more about Carolina House at some point. It's not typical that people stay so long, and that 25 months was broken into two stays, so don't get scared or flee from the mere thought of going if you need residential and are considering it. Most people stay the general 6 weeks-3/4 months. Fun fact: the women featured as patients in the photos on the website are actually staff (two of my very favorites), and I was there when those photos were taken. The whole experience was hilarious.
Moving on. I had heard of and been introduced to DBT - Dialectical Behavior Therapy - before my first admission to Carolina House, but had never discussed it in depth or done "Behavior Chains" (not fun but sometimes useful sheet that takes you step by step through what you were thinking and feeling and how those thoughts and feelings led to maladaptive coping actions), had never been in any well run groups on the matter, and generally just couldn't say that I had really done it. DBT isn't "fun". It's painstaking at times, and a pain in my ass, but it works. My former therapist Eileen led our DBT groups, and I have such faith in her as a therapist (as well as the previous therapists who led that group there) that I am a little biased and prone to believing that it works, as well. It was created by a therapist named Marsha Linehan (known by many of us simply as "Oh, Marsha") originally for patients suffering from Borderline Personality Disorder (I have to add when I mention it that BPD is wayyy over diagnosed, but not terribly uncommon). Silver lining: it's proven to be very effective, not only in the treatment of BPD, but Eating Disorders and many other mental health problems as well.

Short introduction to the concepts involved (my rendition):

DBT deals with three different types of "minds":

1. Emotion Mind,
2. Reason Mind,
3. And yes, the coveted Wise Mind (your whole objective here is to reach Wise Mind and act from a "wise mind place" as frequently as possible).

It's simple, but I'll explain anyway. The "Emotion Mind" is all the way on the emotional end of the spectrum, meaning your thoughts and actions are aligned solely with your emotions and nothing else, which (as many of you may know) can be damaging. On the other hand, acting solely from your "Reason Mind" can also be damaging; behaving solely on what you intellectually know dishonors and rejects/ignores our emotions, which are important, and there's a whole lesson about why emotions are important and what functions they serve that I'll get to another time. Our "Wise Mind" is when these two minds meet and we can behave in balance of both, honoring our emotions while behaving rationally.

There are four different sections of DBT: Distress Tolerance, Interpersonal Effectiveness, Emotional Regulation, and Mindfulness. Today I'm going to teach you a bit about Distress Tolerance.

Our Marsha is a fan of acronyms, as well she should be. Acronyms help us to remember our "Skills" (meaning our new, less damaging or healthy coping skills - often irritatingly referred to simply as "Your Skills" in DBT :-P), and that is good, because she provides us with plenty of them in each section. I was going to focus only on one part of Distress Tolerance in today's entry but decided it might be better to do the DBT blog entries section by section for easy reference, and to distract myself for a bit longer tonight (Distraction is a skill you will soon learn about, friends!).
One last little insider's joke: At Carolina House and I imagine in DBT in general (as CH is pretty much my reference for all things DBT) you are often asked if you're Being "Effective". It gets old, but funny. "What would the more effective decision have been?" they'll ask you. Anyway, so that's what the word "effective" is about if I use it excessively.

Let's get started then, shall we?

Distress Tolerance is meant to help us survive crisis moments; it is meant to get us through the present moment, ideally without using any destructive behaviors (though many believe in a harm reduction model, which I'm cool with too and will cover sometime). So that's Distress Tolerance in a nutshell; gets us through the crisis moment, or very difficult, high emotion/distress moments to get us from, say, a 10 on the crisis scale down to a 9 or an 8, and then we can use more skills to get us down further until we are at a 6 or a 5 and able to make more sound decisions and not hurt ourselves or others. Cool? Cool. Some of what we'll cover today are: Distraction Techniques through ACCEPTS, Self-Soothing using the 5 senses, Improving the moment through IMPROVE, and PROS and CONS.

The first Acronym I have for you today, using Distraction as a skill, is ACCEPTS (as in, "Wise Mind ACCEPTS":

A - Activities. Now, this is open for interpretation - literally anything and everything you can think of that you might want to do or that might be useful to get your mind off of things. There are plenty of lists all over the internet and you may have your own, but I'm going to provide you with an obnoxiously long list of options just in case you're out of ideas at the moment and in need of quick help, with lots of links just in case you're freaking out and need it right now (and for myself to refer to later, of course):

• Do what I'm doing right now. Go to a coffee shop if one is open and write - anything. Journal, write an essay, an article, a blog entry, a poem, a story, letters (that can be fun - bring a batch of fun stationary and write to everyone you know and love, tell them about your day, and then decorate the letters/envelopes if you so desire) - write whatever comes to mind. Or draw. Or browse facebook or blogs or listen to music or people watch or whatever, just get the hell out of your house and to a café/diner/[insert personal preference of a place that's outside of your house but indoors].
• Again, get out of your house (can you tell I'm a fan of this? It almost instantly changes my mood maybe 85% of the time, for better or for worse) but this time to somewhere outdoors. A park, a quarry/swimming hole/the ocean/a pond/some body of water, a Botanical Garden, a favorite spot in your neighborhood, an open field, whatever.
• If you have a car and tend to drive everywhere, like I do, try something new. Go for a walk, take public transit and people watch, ride your bike, rollerblade, skateboard, whatever. I've always been a fan of the idea of taking the subway (called BART in the Bay Area of California, where I'm originally from) to the far corners of my area and going to/seeing places I've never thought of going.
• Exercise (in moderation, if you are healthy enough to do so). Ride your bike, run, walk, go to the gym, swim, rock climb, whatever is convenient, accessible, and practical and healthy for you. Preferably something you enjoy. The following is NOT a suggestion for those of you with eating disorders - got it, kids? - sometimes people (who DON'T HAVE EATING DISORDERS) find it helpful to calm themselves down by doing a bunch of sit ups really, really fast, or something of the like. (NOT THOSE WITH EATING DISORDERS. SERIOUSLY, I SEE YOU, MOVE ON TO THE NEXT ONE.)
• Again, possibly not for those of us with eating disorders, cook. If you have an eating disorder and cooking is a "safe" thing for you to do and you won't have problems with food in the house, or you're in recovery and the same is true, then go for it. Go through one of your mom's cooking books or google recipes that include ingredients you like. Make something for a friend or neighbor, or you know, yourself. Cook yourself a gourmet meal :) And if you have a few extra bucks, spring for an ingredient you don't usually have in the house but enjoy. Make grocery shopping a part of the experience. Dress up, get out, get the groceries, and spend time cooking.
• Take a shower/bath (*I'm going to repeat myself on this one when I get to the 5 senses, but whatever). Showers are extremely helpful for me nowadays. Some people have trouble with showers or baths for whatever reason, so if you're one of them, obviously, skip this one. But the shock of a different (safe) temperature and the feeling of being clean can both be really, really helpful.
• Call a friend (it figures I would forget this one until now) - or email someone, text someone, write a letter - just contact someone you know in some way that helps you to feel connected; you can choose to tell them what you're experiencing if it would be helpful and feels appropriate, or you can not. I personally write a lot of emails and letters, and while I'm doing so it helps me to feel connected to the person I'm writing to. If possible, move on to the next:
• Get together with a friend or family member. It's helpful to make plans in advance, but I understand that a lot of us with long standing mental health issues don't have a lot of people or established relationships in our lives (which blows, I know) so you might want to work on building some. Again, if you have some people, contact them. If the people in your life are busy, or unavailable, start making some new friends in addition to them - go to http://www.meetup.com/ and create an account, punch in some of your interests, and find some local groups to attend. Some people might find therapy groups or free community support groups helpful. A tip from me: I don't. I find them depressing. Gage where you're at, try them out, and see what YOU think. Find an online forum, either for those suffering with mental illness or not - maybe find a forum for one of your weird interests, like collecting porcelain dolls, or something awesome like Harry Potter fanatics.
• Read. You can choose to read self help books, workbooks on Depression or whatever your particular affliction is, or pick a really good fiction or non-fiction book. Go to the library or bookstore and pick something out that you think you'll like. And a tip someone once gave me: life is too short for crappy books. If you don't like it and you're not like me and compulsive and have to finish it anyway, move on. There are lots of books in the world. Create an account on http://www.goodreads.com/ (the best, most awesome website for readers - you can make lists of books you have read and review them, make lists of books you're currently reading, and a long list of books you'd like to read; you can also read other people's reviews of books you like or dislike or are interested in reading, whatever). You can read poems you find inspiring, articles, essays, whatever.
• Watch TED talks - I find this incredibly inspirational. Go check it out if you haven't heard of them. Watch Youtube videos of something fun. A few ideas: flash mobs, people unwrapping gifts of new kittens or puppies (a surprising number of them cry), break dancing, whatever. If you have a Netflix account, watch a documentary or a movie or a show you like, or find one you like. Or, if you don't, go to http://www.hulu.com/ and watch shows or movies or funny clips for free. Watch something. I like horror movies.
• Make coffee or tea. Drink and savor.
• Take a nap, if you're able and need to zonk out. Just don't overdo the sleeping meds.
• Garden. Buy a plant. Take care of said plant.
• Play with your pet, if you have one. If you're stable enough to get one, go get a fish or a cat or a dog. My cat, Sigmund (yes, after Freud) continually saves my ass and I love him to little bits. He's so good for me. It's a fun story really, my adoption took place impulsively in the middle of the night while I was still in treatment. For another time. If you don't have pets or aren't stable enough to have one, go to a shelter and play with the animals, or play with your family pet or a friend's.
• Shop. Try not to overspend. If you don't have money and can stand it, go look at fun things. Go sit in a furniture store with really comfortable furniture and try it out, or go to a little joke shop or boutique. If you don't have body image issues, try on different outfits. Put together a care package for a friend, or even for someone you don't know; put together a care package for that homeless guy you always see on the side of the road and talk to sometimes. Even more fun, find out what music he/she likes and burn him/her a CD and buy a cheap CD player to give them, because giving them a CD without a CD player is stupid. I've done that, and found it extremely rewarding. He liked Michael Jackson a LOT.
• Volunteer. I'm going to repeat that one, so moving on,
• If you're into it, do a crossword/word search/brain game of some kind.
• Go for a drive. Blast your music. Depressing or not - it's up to you! :-P
• Burn candles and incense if you're a hippie like me. Play some soothing music. Which brings us to:
• LISTEN to music. In general. All the time. So you can't think too much. An old sponsor of mine, when I was new to a particular 12 step program, gave me a CD player and a couple of burnt CDs and told me to do this. It helped.
• Listen to podcasts.
• Read the news or go on National Public Radio's site and read or listen to news stories, if it doesn't get you too down. Educate yourself.
• Speaking of educating oneself, do homework if you're a student, or pick a topic that interests you and read/research online (anything from the formation of species to mermaids, I don't care).
• Draw/Paint/Collage/Create.
• Go on http://www.pinterest.com/ and become obsessed for a few months like everyone else.
• Scrapbook, if you're into it.
• Start a picture album of happy memories.
• Go to http://www.beliefnet.com/ and explore various religions/spiritual practices, google them, or read about them.
• Read crappy magazines.
• Chain smoke if you're already a smoker like me. But don't blame me when you get sick, and don't start if you don't smoke. This would be under "harm reduction".
• Start a collection of something (but don't hoard shit) - seashells, sea glass, beer caps, postcards, whatever.
• Read all of the books by a single author you love.
• Read an entire book in one sitting (a fun one).
• Paint your nails
• Do a self makeover
• Make lists of all the things you want to do/places you want to see/etc.
• Dye your hair
• Get a piercing
• Get a tattoo (only if you've been thinking about it awhile and know you've been wanting to for a long time - NOT IMPULSIVELY!)
• Obviously I am liberal
• Moving on

Okay, that's my list for you. Google "Coping Skills" or google "Adult Pleasurable Activities List" if you want more. It's a DBT thing. On to the next skill:


C - Contributions. This is my favorite. I'll probably repeat some of my previous suggestions, but here you go:

• Visit a friend in the hospital (I did this today, which is why it's first. Three separate times, since I have no life. It sucks if you have a friend in the hospital, but it sucks even more to BE in the hospital and not have visitors. Bring them a bunch of crap you'd like/need if you were in the hospital, or things you know THEY would like or need.)
• Make a care package for someone.
• Buy someone a gift.
• Write someone a letter.
• Volunteer - pick something you're passionate about or start figuring out what you are passionate about - gay rights, literacy, homelessness, a Children's hospital or a hospice, global warming, animal shelter, whatever. Or google volunteering opportunities in your area.
• Bake something for someone.
• Babysit or pet sit.
• Do something surprising or special for your partner, mother/father/brother/sister/nephew/cousin/aunt/whoever.
• Make something beautiful for someone else.
• Google nice things to do for people.

E - (Opposite) Emotions. Opposite to Emotion Action is a huge thing in DBT I'll get to another time, but for the purposes of this particular blog entry, do something that can provoke a different emotion or help you to vent/experience the one you're in if you're having trouble accessing it, crying, whatever. Suggestions:

• Watch a funny/happy/sad/scary movie or show
• Read a funny/happy/sad/scary book
• Listen to funny/happy/sad/scary music (is scary music a thing?)
• Ponder whether Scary Music is a Thing
• Draw/paint/collage something about how you're currently feeling or how you'd prefer to be feeling
• Make a list of affirmations (if affirmations are a thing for you - basically positive things about yourself or the world - for me it only helps if they're things I already believe, so really put some thought and time into them) - and put them in a box/jar/whatever, decorate it, pick one out.
• Read recovery blogs
• Watch TED Talks
• Google a list of opposite to emotion actions

P - Pushing Away (they say to use this as a last resort because obviously you're going to want to come back to whatever is bothering you and actually DEAL with it, but if you need to do this, that's totally acceptable)

• Basically ignore whatever is bothering you and move on to something else. You can use Imagery and picture yourself putting it in a box on a high self in your imagination, or picture yourself building a wall between yourself and the situation, whatever. Or google this if you want a different opinion/explanation of this skill. Not my favorite.

T - Thoughts. Distract with other thoughts.

• Count things
• Count colors on a tree
• Read
• Watch a movie
• Watch videos/whatever
• Crossword puzzles/word searches/whatever
• Also not a fan of this one, clearly.

S - We have arrived at Sensations.

• Hold ice (big thing at Carolina House, I thought it was the weirdest thing at first but it can help shock the system into thinking or feeling a little more clearly/sanely)
• Take a (safely) hot/cold shower or bath
• Get silly putty and play with it
• Stick your feet in the sand somewhere
• Put lotion on yourself (if it smells good, that's awesome)
• Put a rubber band on your wrist and snap it (obviously this is to avoid self harm or some other type of harmful behavior and also falls under harm reduction)
• Listen to very loud music
• Smell all the lotions/candles at the store and look like an idiot like I often do

Whew! Okay, done with ACCEPTS. Holy crap, I've been at this for two hours. I may not finish this one tonight - or I might, since I'm compulsive. On to Self Soothing using the 5 senses.

Self - Soothing Using the 5 Senses

1. Vision -

• Walk in nature, a botanical garden, around your neighborhood, the beach, wherever you like and observe what's around you. Preferably a nice, safe, pretty area.
• Go to a museum and look at art if you're into art.
• Google art.
• Watch a movie with awesome cinematography.
• Light a candle and watch the flame.
• Watch the ocean/pond/lake/body of water near you if there is one.
• Buy a flower and put it in a vase in your apartment. Or a bouquet. Or pick flowers in a field (preferably legally) and dry them or press them AND make someone a gift and Contribute while you're at it!
• Go to a bookstore and find the art section and look through all of the art books
• Look at an Anatomy book
• Look through kid's books at the pictures
• Look at photographs that make you happy, or that scrapbook/album you've been working on
• You get the idea.

2. Hearing -

• Listen to music
• Listen to a podcast
• Listen to NPR (which for some reason I find soothing as hell)
• Download/listen to sounds of nature (waterfall, RAIN [god I love the sound of rain], birds if they don't annoy you too much, whatever)
• Take a shower and sing and listen to the echo
• Take a shower and tap the wall while you sing and listen to that
• Listen to a song and focus only on one component; the piano, or the guitar, or the words, etc.
• Listen to something almost imperceptible, like the crackling of a candle's wick
• Listen to old voicemails that make you happy (and save them when you get them so that you can do this)
• Listen to traffic going by
• Go to a coffee shop and eavesdrop on people's conversations (yeah, I'm actually telling you to do this so don't feel like a creep)
• And so on.

3. Smell -

• Light incense/awesome smelling candles
• Decipher your favorite scents (cinnamon, vanilla, lavender, tea tree, patchouli, sage [smells like weed to me so if you're a stoner by all means], chocolate, pumpkin, "fresh linen" [whatever the hell that means], the ocean, "rain" scented things, whatever you aren't allergic to and like - and seek them out.
• If it's safe for you/hashtag you don't have an eating disorder and a problem with this, bake fresh bread or muffins and let it smell up your apartment/house/kitchen.
• one of my favorite Marsha suggestions - boil cinnamon
• Buy a Rosemary plant, rub its leaves and smell your fingers. Seriously. (To the person who gave me one on my birthday, if you're reading this, thaaaanks :-P)
• Pick/grow lavender.
• Go to a botanical garden and smell everything.
• Brew fresh coffee/tea and smell it while you enjoy it.
• Put on your favorite lotion, or go out and smell a bunch of different types until you find one you like (for instance, I never knew I had such a passion for Brazilian Nut until Target and DBT meshed one day)
• Cook, if it's safe for you
• Bubble bath time!
• Shower gel fun stuff time
• Perfume section of a store if you like perfume
• Put straight vanilla on your fingertips and smell them (I loveeee vanilla)
• Go into a hippie shop and just breathe in

4. Taste - Tricky for those of us with eating disorders/eating problems. Do as is safe for you. You be the judge.

• Cook yourself your favorite meal and enjoy it
• Go out and eat something yummy
• Suck on a mint/hard candy and "Be Mindful" of the experience (pay close attention and don't rush yourself)
•  Chew gum (try a new flavor)
• Brush your teeth (and if you want to have fun, get kid's flavored toothpaste, unless that disgusts you in which case I didn't suggest it)
• Floss your teeth
• Drink tea or coffee or hot chocolate

5. Touch -

• Pet your animal, if you have one. Give them extra love.
• Put on the most comfortable clothes you have.
• Change/wash your sheets and covers, lay in your bed, and enjoy both the feel and the awesome smell of clean stuff (same with clothes)
• Take a nice shower or bath and pay close attention to how the water feels
• Hug a stuffed animal (even if you're 25 you might, for instance, have a stuffed cat named Cuddles you still sleep with)
• Get/wear fuzzy slippers or cozy socks
• If you're an artist, get a batch of different types of drawing pencils and pay close attention to how each one feels to draw with
• Give yourself a little massage somewhere
• Or if you have the money and it's safe/comfortable for you go and get a massage
• Ask someone for a hug
• Paint yourself. Yes. Like your body. And then wash it all off in the shower (it's so much fun to watch all the colors run down the drain, not that I've done this.)

Alright! Whew! On to IMPROVE the moment:

I - Imagery.

• Do a guided meditation
• Invent a "Safe Place" (another DBT skill) - it can be and feel and look like anywhere and anything you want, imaginary or real, and you get to choose everything about the environment - and go there whenever you want to.
• Listen to a recording of the sounds of nature, close your eyes, and picture the surroundings. Similar to safe place. Make it however you want it, use your imagination!
• Read poetry that is extraordinarily descriptive (Mary Oliver is great for nature stuff)
• Draw something and lose yourself in it
• Go to a museum and pretend you are in a painting
• Do the same on the computer while you're googling art
• Etc.

M - Create Meaning

• I like to do this: imagine yourself ten years from now, helping others with the struggles you have undergone. Imagine that none of it was for naught; imagine that you take every moment of excruciating pain you have endured and use it to improve someone else's life, and that it works. Fantasize about how the pain you have endured will benefit another living, breathing, suffering human to suffer less.
• If you're into this sort of thing, imagine/put some thought into/journal about how your struggles have made you into the person you are.
• If you are religious or spiritual, do whatever religious/spiritual people do with meaning stuff (clearly I am of no help in this area, google it!)
• Absolutely no cop outs on this one: read the book "Man's Search for Meaning" by Viktor Frankl. He is incredible, as is the book (which is first about Dr. Frankl's experiences firsthand in a concentration camp, his extraordinary strength throughout, and secondly about a meaning based therapy he developed called "Logotherapy" - which I find extremely intriguing). Google and read about Logotherapy.
• Read articles on Existential Positive Psychology (this is a thing! My old doctor introduced me to it because she is brilliant. So is it, especially if you're an atheist). Google it and learn more.
• Try to make meaning of your pain/experiences somehow, or
• At least think about the reasons YOU and your personal existence are meaningful - even if it's as small as your cat needing you. Ehem. Anything personal to you.

P - PRayer:

• So it's probably pretty clear by now that I personally do not pray. But if prayer helps you and you "know how", go for it. Write a letter to the God of your choice.
• Aforementioned old sponsor who was also an atheist used to tell me that if something helped, it wasn't my business to question it. So even if you're an atheist, if you're open minded to it, try praying - to whatever you want. If you aren't open to it, that's cool too.
• This might not exactly be prayer, but just talk out loud.
• Or talk to your cat who happens to be named Sigmund.

O - One thing in the moment:

• Focus on only what you are doing in the moment. Do something like:
• wash the dishes, and focus on the smells and sensations and the glint of glass or metal in the light.
• Be fully engaged in a conversation you are having.
• Pet your animal, and do only that. Again, "Be Mindful" of the experience, paying close attention to every component of your 5 senses, and how you are feeling as you do it (only if that's helpful and not depressing).
• Journal.
• Watch a movie and dive into it. Do the same with anything else.
• Do your laundry and listen to it bang around in there.
• Breathe, count your breaths, and focus on the air going in and out of your lungs/nostrils/mouth (if focusing on your breath doesn't make you anxious).
• Memorize a poem you like, or anything else. The Constitution, for instance.
• Listen to a song. Be mindful of it. And maybe sing too. That's two things, but I'll allow it.
• Craft
• Whatever

V - Vacation: You can be literal about this and actually plan and go on a vacation, or - even better and cheaper - go on a MENTAL VACATION! (*winks*) - the important thing is not to use this to totally ignore reality, so set a time limit or, if you can, just be reasonable and know when enough's enough.

• Use imagery
• Go back to that Safe Place
• Take a 20 minute nap
• Play a video game
• Go on a short walk
• Draw/paint/collage/whatever
• Take a vacation from adulthood (if you're an adult) and go back in time...read books you read as a child (though I warn you, you may be sorely disappointed when you realize how poorly written they are, like I was when I tried to revisit Goosebumps...I've graduated to Stephen King, don't worry), watch your favorite movies from childhood, cuddle with that stuffed animal I know you have (or get one), etcetera.
• Read. Seriously. Try reading out, it's pretty incredible. If you hate reading, please do not talk to me ever. (I'm just kidding, seriously, it's okay.)
• Go to the park or a quarry or beach or someplace you like.

E - Encouragement:

• Tell yourself "Cheerleading Statements" - cheer yourself on in the way a friend would.
• Imagine what a particular person who loves you would say (that would help).
• Write a nice letter to yourself for difficult times. Read it during difficult times.
• Listen to music you find inspiring.
• Watch TED Talks you find inspiring, or movies, or whatever.
• Call someone in your life who you know will help encourage you.

Oh Em Gee we're down to the last one! GO TEAM! If you've made it this far, I am IMPRESSED with you. You're awesome. Thanks for reading because this is taking me a lottttt of time. But it's helping me, so no worries, and you're worth it 'cause you're great, I'm sure of it. (I might be that encouraging person on some days if you want to write to me. Being me, I will probably write back.)

Okay, PROS and CONS:

• Quick and dirty: Write out a list of the pros and cons of "Tolerating the Distress", AND the pros and cons of "Not Tolerating the Distress" (somewhat repetitive but there is a distinction, trust me).

And we're done, and you are a ROCKSTAR for hanging in there with me. Seriously, if you read this or even just browsed, or are on my page at all, THANK YOU. It is helping me tremendously to write it for an number of reasons and it means a lot to me that you're taking the time to do so.
A quick update on me...
Today is the best day I've had in awhile, primarily because I spent it visiting my friend (as mentioned, three separate times, using my Contribution skills), taking little breaks for myself, and blogging. I showered, which always helps me feel better (I promise you, you will find little things that help you if you just experiment and hang on long enough to do so)...I took my meds, which I've been saying might as well be sugar pills for all they help me...I spent time with my cat, I watched Grey's Anatomy on Hulu, I watched TED Talks which I'm obviously obsessed with, and I spent all this time reviewing my Distress Tolerance Skills and helping you, which helped me in turn. The weather was beautiful, and all in all, today was a great day. I feel privileged to have you to write to, for what it's worth, whoever you are. As Mary Oliver says in her poem "Wild Geese":

"Whoever you are, no matter how lonely, the world offers itself to your imagination..."

And now I'm watching my cat jump at my sliding glass door trying to catch a moth. Life isn't so bad, yeah? But really - there are good days and terrible days. As I mentioned briefly in a different, quick way in a previous entry, my best friend died in July. I have horrible Depression. I'm in early recovery from a severe, nearly lifelong eating disorder, and it's rocky. My friend is in the hospital. My other friends are pretty amazing, but pretty busy. I love my family, but we have our stuff like everyone else (and then some - sorry if you're reading, mom, I love you). My uncle just died, as did another friend (both in the last two weeks), and then I got news of another death from a girl from another old treatment center of mine. It seems like a lot of my peers are dying right now, and it's disillusioning and sad. I've lost a lot to my eating disorder. I haven't gone into much detail concerning my anorexia and bulimia because quite frankly I am bored with the subject and trying to move on, but please don't misconstrue that and think that I don't know what it's like. I've lived with it since I was nine years old, and it's hell, and it's real, and I swear to fucking god it kills, it kills, it kills, in more than just the literal sense. I'm thankful every day that I am able to access good care, and if it weren't for a lawsuit and the incredible lawyer who saved my life (I'll mention her here, miss Lisa Kantor) and the Carolina House, I would be dead today. No doubt. I won't lie to you - I'm still shaky and scared and vulnerable and early in my recovery. There are things I don't mention in this blog because I'm not comfortable enough to put them out there, with regard to the eating disorder. But my brain is a fucking battleground every day with that fucking thing, and it gets so, so old.
So things are...you know. Shitty, a lot of the time. And then not so shitty at others. And I'm hoping with continued hard work, they'll get better.
Back to my best friend, who passed away on July 10th of 2013. She was an exceptionally private person, so I'm not going to go into details about her life or her death, but I've become very close with her family, who live in Chicago, and on Wednesday I am flying out for her sister's wedding. I'm very excited and can't wait to see her sister, her mom, her aunt, her grandpa, her sister's fiancé, her cousins...I could go on and on. Nothing that ever comes of Chrissie's death will EVER, ever, ever, ever, ever make it okay for me - got it? I'd undo everything to have her back - but if I were to try to apply "Creating Meaning" to this situation, one thing that's come of it are my beautiful relationships with her beautiful family. Another is that she is no longer suffering. But I pity a world that doesn't get to have her in it.
So the wedding is coming up, and that's exciting. Afterward I will be completing residential treatment (20 months and I'm not quite done) at ERC in Denver. It's a long story that I don't feel like telling right now, but that's happening, and I'm going to mention it since it's kind of a big thing. I believe I will still have access to the internet and thus will be able to keep up with this blog.
That said, GOODNIGHT FRIENDS!
With love,
Sofia